Transcriber: Nika Kotnik Reviewer: Denise RQ
When I grew up, I never knew three of my grandparents.
They were dead by the time I was two.
One of those was dead by the time I was one year old,
she passed away due to lymphoma.
When I was in elementary school, I was talking with some friends of mine
and one kid said, "I've got four grandparents!"
And I said, "I must have four grandparents too."
That kid said,"No, you don't."
I said, "Why don't I have four?
It's fair. Everybody should have four grandparents."
But I didn't. I never knew three.
Growing up, what I saw in the environment,
was a situation where almost every month, another extended family member,
another friend of the family, would come down with cancer.
That was a very difficult thing for me.
I grew up really loathing the disease.
And I think a lot of you felt the exactly same way about that.
After studying the disease for more than 20 years,
I have come across a couple different findings,
and I wanted to share those with you.
One of those is we will never cure cancer,
we will never win the war on cancer.
Unless we know it personally.
What do I mean by that?
Sun Tzu said in his book "The art of war",
that you must first know your enemy,
then know yourself, and then you need not fear the results of over 100 battles.
This is some very dated pictures of myself.
Obviously I was a lot younger back then.
What I learned from those experiences was to take a look at your enemy,
know what makes them tick, look at yourself,
can you combat those two different aspects?
One of the things that was very interesting
about this specific deployment I was in
- this was some pictures that were taken during the first Gulf War-
was that the Gulf War, the actual ground war,
was over in about 72 hours.
Of that time I was awake about 30 hours.
I had a good friend of mine, a high ranking officer, talk to me,
after the conflict was over and he said: "Did you know
we actually predicted the survival rate of your unit?
Based on the situation you were put in,
breaching the minefields [and the equate].
I said: "That is pretty cool.
What was the percentage of survivability that they expected our unit would have?"
He said: "Well, they expected about 2% of your unit to survive."
And that number has always stuck with me.
Because fast forward about ten years after this,
I am a young post-doc in a clinical setting
where we have got patients come in.
I am in oncology group, Ob/Gyn clinic,
so we see a lot of patients with breast cancers and ovarian cancers.
We'd go to grand rounds, and these patients would be coming in,
and basically, there were only two drugs
that would be prescribed to all of these patients back then.
That's it.
For broad chemotherapies, actually I can list them off the top of my head:
Cisplatin and 5FU were their actual names.
And I thought: "Why are we even discussing these patients?
It is pretty crazy.
Why don't we just rubber-stamp it? We don't need to even discuss them.
Let's give them the two drugs."
So imagine waging a war on an enemy where you're told
you can only use two types of resources.
The Gulf War was pretty much a tank war,
but what if we were told: Sorry, can't use tanks in that engagement."
That is the same way. I am addressing the same enemy.
Now I am fighting cancer on a different front,
and I am [told] we can only use two types of resources?
There has to be something else that goes on with that.
Say I had two patients come in, they present themselves,
and they both have, for example, breast cancer.
We look under a microscope and they are completely identical in every way.
The histology says they are completely identical.
So what I have here is a practical example - I couldn't bring in any patients -
we have two pieces of metal,
those pieces of metal look highly similar to each other.
I'm just going to drop them in water, this is just water.
If all goes well, we'll be able to find out what happens.
I don't know what order they are in so we'll be surprised.
Completely identical, we don't know how they're going to react.
Not much of anything in that one.
I guess you could call that the dud sample.
We'll drop this one in, see what happens here.
But whose were two identical pieces of metal, they were practically the same.
Why didn't they react the same?
Because at the molecular level, they were completely different.
That is why we started doing
the type of work where we were looking at the patient's genetics, and saying:
"At the DNA level, these patients are completely different.
So their treatment should be completely different,
tailored to what their DNA is saying."
I was very proud to be associated with a lab,
who started cloning some of the first breast cancer tumor markers.
We did what was referred to as fluorescently in situ hybridization,
where we actually take a fluorescent labeled piece of DNA
and then we probe the patients cells.
This is an example here.
Each one of these blue blobs is a cancer cell.
If you see two dots that is a good thing.
If you see a lot of red, that is a bad thing.
These patients were both labelled as having breast cancer,
but at the genetic level they are very different.
What we wanted to be able to do
was tailor that information to the aspects of their treatment.
One of the problems was
we were moving into an area referred to as personalized medicine,
meaning you can take this information and drive therapy.
But the problem was we could do one patient a day,
looking at about one gene a day.
There's thousands of patients and about 20 to 25,000 genes in the genome.
any of them [could play a problem with the disease.]
It's an insurmountable task, there is too much to be done.
So what we started looking at was were there other types of technologies
we could use to diagnose the DNA aspects,
and look at the genes themselves?
We started looking into DNA sequencing.
DNA sequencing, if some of you have kept up with that technology,
the human genome project was completed about 13-14 years ago.
For one patient it cost
more than a billion dollars, and it took about 10 years to do.
So we're not using that technology on a day to day basis.
Things have to be sped up.
And lo and behold, what happened with researchers
is they started applying different types of technologies
into the life-science setting,
and this is the schematic of the dates and the cost per human genome.
You look 13, 14 years ago at how much it cost and how long it took,
today, if you wanted to get your genome sequenced,
you could go, and it would probably take you two weeks,
and it would cost roughly about 1,000 dollars.
That is a pretty amazing advancement in technology.
If we were to apply
the same rapid progression of technology to another industry,
what would that look like?
For this talk I chose a Tesla automobile.
I like Tesla, so I'm not picking on them.
If you'd take a Tesla automobile and apply this same rapid progression of technology,
that 100,000 dollar automobile, 15 years from now,
would cost you 33 cents,
and would go 500 times further than the current models.
That is an amazing progression of technology.
We're taking these types of data and we are actually using them
to look at the patients' genomes.
What are all of the ground aspects of the DNA?
What are they doing as far as the genetic level?
How do those genes interact?
They are looking into network science,
how those genes interact with each other, and how they affect the disease.
A few years back my daughter came to me with a very poignant question,
she said,"What is polio? I've never heard of polio."
I was really struck by that question
because 75 years ago,
if we were in a room like this, and someone said the word polio,
I bet you people would be running for the doors.
Because it is that terrorizing of a disease.
Now people don't even know about it, that is amazing.
What if in 75 years from now,
our grandkids or great-grandkids would say to us:
"What is cancer? What is breast cancer? I've never heard of that before."
Wouldn't that be amazing? That would be amazing.
That is the type of work we're progressing towards,
Where we are looking at these patients and saying:
"What does their DNA say? What do their network say?
Can you actually guide treatment based on an individual?
Should they take a certain type of drug? Should they incorporate exercise?
These are the types of things that we are using on a day to day basis
and we'd like to speed that up even more so for the future.
I am a big fan of Isaac Asimov, he's written some pretty cool stories,
and one of the quotes that he stated was:
"Life right now is that science gathers knowledge faster
than society can gather the wisdom behind that."
There is a lot of questions that need to be asked.
Yes, you can get your genome sequenced in two weeks.
Yes, it can cost roughly 1,000 dollars.
Now what are you going to do with that data?
Are you going to share it with a friend?
Are you going to share it with people you don't even know?
Is that person going to come back to you and say: "You know what?
You might get cancer in the next five years,"
or "You might have a genetic propensity to have obesity,"
Or,or "You might have issues with children if you decide to have them."
These are the types of things
that society is really struggling with right now.
But we would like to be able to take all of this data
and incorporate it into an aspect where you can take a persons genome
and record all of these other aspects of knowledge and then say:
"Yes, we want to guide these networks."
And just like a battlefield, take this very strategic map, apply it and say:
"Are there areas at this battlefield map that I want to avoid?
Are there areas where I want to be?
Is the enemy lurking in aspects of these valleys?
I want to be on these peaks,
I want to stay away from the enemy in these certain areas.
Anything that might affect disease.
The really good thing is we are made up of our genes,
but that's only half of the equation, the other half is the environment.
So I might have three different patients,
their pathways might be affected in three different ways,
and yet, they might have three different treatments.
Forget 15, 20 years ago,
when we had treatments where everybody was treated the same.
We are all different.
Our genes tell us completely different things about us.
We shouldn't be treated the same way.
What I would like to reiterate with you is
that we will never be able to have a definitive single cure for cancer,
but we might have tens of thousands, millions of cures for cancer,
and that is because it comes from everyone of us.
So first of all, I'd like thank those people who are currently involved
in supporting cancer therapies and research,
there are probably people in this room who are really supportive of that,
I stand with you and I thank you for that.
I also thank all those people out there
that are struggling with the disease right now, and let them know
we are standing with them in this fight, and we are going to win.
Thank you very much.
(Applause)